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Open Access Case report

Regional secondary focal segmental glomerulosclerosis in a transplanted kidney – resolution with treatment of a segmental renal artery stenosis

Daiki Iwami1*, Hiroshi Harada1, Hiroaki Usubuchi2, Kiyohiko Hotta1, Toshimori Seki3, Masaki Togashi3 and Yuichiro Fukasawa4

Author Affiliations

1 Department of Kidney Transplant Surgery, Sapporo City General Hospital, 1–1, Kita 11, Nishi 13, Chuo-ku, Sapporo, Hokkaido, 060-8604, Japan

2 Department of Medical Imaging, Sapporo, Hokkaido, 060-8604, Japan

3 Department of Urology, Sapporo, Hokkaido, 060-8604, Japan

4 Department of Pathology, Sapporo City General Hospital, 1–1, Kita 11, Nishi 13, Chuo-ku, Sapporo, Hokkaido, 060-8604, Japan

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BMC Nephrology 2012, 13:38  doi:10.1186/1471-2369-13-38

Published: 12 June 2012

Abstract

Background

Conditions associated with high intraglomerular filtration pressure can cause secondary focal segmental glomerulosclerosis (FSGS). Unilateral renal artery stenosis (RAS) or its occlusion results in FSGS-like changes and the nephrotic syndrome in the contralateral kidney due to hyperfiltration. However, it has been rarely reported that stenosis of a renal arterial branch can result in FSGS-like changes in a different portion in the same kidney allograft.

Case presentation

A 60-year-old male kidney recipient developed allograft dysfunction after angiotensin II receptor blockade for hypertension 4 months after transplantation. It was proven that one of two arterial branches of the graft was markedly stenotic. Graft dysfunction improved after percutaneous transluminal arterioplasty (PTA), however; the stenosis recurred and massive proteinuria developed 5 months later. Graft biopsy showed ischemic changes in the region fed by the stenotic artery branch and in contrast FSGS-like changes in the region fed by the other branch. His clinicopathological manifestation including massive proteinuria almost normalized after the repeat PTA.

Conclusion

Here we report a case of secondary FSGS of a kidney allograft due to severe RAS of a branch of the same kidney, in which clinical and pathological improvement were confirmed after radiological intervention. When moderate to severe proteinuria appear, secondarily developed FSGS as well as primary (recurrent or de novo) FSGS should be taken into account in kidney transplant recipients.

Keywords:
Kidney transplantation; Nephrotic syndrome; Renal artery stenosis; Secondary FSGS (focal segmental glomerulosclerosis)